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24M more uninsured due to Republican health plan could crowd ERs, force hospitals to slash programs

Updated on March 16, 2017 at 8:50 AMPosted on March 15, 2017 at 5:00 AM

Paul Ryan, Steve Scalise, Cathy McMorris Rodgers, Kevin McCarthy

Ohio hospitals and healthcare providers caution that the high number of uninsured people projected by the CBO report on the Republican plan to repeal and replace the Affordable Care Act will have a "ripple effect" on the state and local economy, as well as the quality of care for many Ohioans.
(AP Photo/ J. Scott Applewhite)

CLEVELAND, Ohio -- Increasing the number of uninsured Ohioans will have a profound impact on hospitals and patients as well as on the quality and cost of care we all receive, local hospital systems and healthcare providers warn.

It's not yet clear exactly how many people in Ohio will be uninsured, or who those who lose coverage may be, though most providers suspect Medicaid recipients will be the hardest hit.

Ohio was one of 31 states to expand Medicaid eligibility under the Affordable Care Act. Eligibility was extended to many working adults who previously had no insurance, with the federal government paying the full cost of the expansion until 2020. About 700,000 Ohioans got their insurance through the ACA's Medicaid expansion.

A recent Center for Community Solutions report estimated that the state could fall behind by more than $25 billion in covering Medicaid by 2025 given the proposed changes in the new legislation, with many beneficiaries losing coverage.

But, says Dr. J. Mario Molina, CEO of Medicaid managed care provider Molina Healthcare: "This is not just about what happens to Medicaid."

It's also about what happens to uninsured patients once they lose coverage, and the ripple effect on hospitals, insured patients and the economy.

"Many Medicaid recipients will lose their coverage, and they'll end up in the same place that they used to end up, which is the emergency room," he said. "Emergency rooms will become overcrowded, making it more difficult for people with insurance to gain access to care there."

Molina expects the burden of uncompensated care -- the cost borne by hospitals when patients can't pay their bills or don't have insurance -- will put some smaller hospitals out of business.

In Ohio, more than one in five hospitals are operating on negative or very slim margins today, according to the Ohio Hospital Association (OHA).

"Expanding the uninsured would create health care challenges and increase hospitals uncompensated care, which was over $5 billion in 2014," said OHA spokesman John Palmer.

It's also a worry for the MetroHealth System and the Cleveland Clinic, which are closely monitoring the proposed legislation's progress through committee hearings.

The Clinic said while Medicaid reimbursements are not enough to cover the cost of care, they help to reduce the Clinic's uncompensated care and bad debt costs. Losing Medicaid patients is therefore a concern for the health system.

It's likely a larger concern at MetroHealth, which provides the majority of Cuyahoga County's uncompensated or "safety net" care, and where 28,000 new Medicaid expansion patients may soon lose coverage.

"It's clear that individuals will likely lose coverage at an alarming rate," said Tracy Carter, MetroHealth's senior director of state and federal government relations.

The ACA phased out government Medicaid payments provided to hospitals like MetroHealth that used to see a disproportionate share of uninsured patients, and the Republican plan would only reinstate these in Ohio in 2020.

"We'll continue to serve those patients because they're in need, but there's a cost to that," she said. "At some point you have to recognize we're a business too. You can't continue to provide services and not get paid."

That means shifting the cost of caring for the uninsured onto others, or cutting existing programs and services provided to patients for free as a community benefit, Carter said.

"We're going to have some uncomfortable conversations about which programs and services we would maintain and which we'd cut," she said.

"We all pay, when it's all said and done," Carter said.

Molina is frustrated that the Republican legislation, like Obamacare before it, does nothing to truly contain the rising costs of healthcare. It only shifts them around.

Yet programs that have reduced healthcare delivery costs, like Ohio Medicaid, are being threatened, he said.

And Medicaid expansion doesn't just cut costs for Medicaid beneficiaries. A 2016 report from the the Office of The Assistant Secretary for Planning and Evaluation (ASPE) showed expansion also benefited state residents with higher incomes who obtained coverage through the marketplaces, and those in the individual market by lowering marketplace premiums.

More states need to be allowed the flexibility to implement new and innovative Medicaid programs that reduce the overall cost of delivering healthcare, Molina said.